Ness County Hospital

All Charges

Charge

Type

Setting

Price

PLETAL 100 MG TAB (CILOSTAZOL)

Facility

$6.00

Service Code	NDC 50268017711
Hospital Charge Code	2514255
Hospital Revenue Code	250
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$5.06
Rate for Payer: Celtic Commercial/Exchange	$2.77
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$5.04

PLETAL 100 MG TAB (CILOSTAZOL)

Facility

$6.00

Service Code	NDC 50268017711
Hospital Charge Code	2514255
Hospital Revenue Code	250
Min. Negotiated Rate	$4.92
Max. Negotiated Rate	$5.82
Rate for Payer: Cash Price	$5.06
Rate for Payer: Health Partners Plans Commercial	$5.70
Rate for Payer: UnitedHealthcare Commercial	$5.82
Rate for Payer: WPPA Commercial	$4.92

PLEURAL EFFUSION WITH CC

Facility

$10,089.83

Service Code	MSDRG 187
Min. Negotiated Rate	$10,089.83
Max. Negotiated Rate	$10,089.83
Rate for Payer: BCBS Commercial	$10,089.83

PLEURAL EFFUSION WITH MCC

Facility

$14,416.37

Service Code	MSDRG 186
Min. Negotiated Rate	$14,416.37
Max. Negotiated Rate	$14,416.37
Rate for Payer: BCBS Commercial	$14,416.37

PLEURAL EFFUSION WITHOUT CC/MCC

Facility

$7,822.08

Service Code	MSDRG 188
Min. Negotiated Rate	$7,822.08
Max. Negotiated Rate	$7,822.08
Rate for Payer: BCBS Commercial	$7,822.08

PLEURX CATH SYSTEM KIT

Facility

$240.00

Hospital Charge Code	2709377
Hospital Revenue Code	270
Min. Negotiated Rate	$110.88
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$180.00
Rate for Payer: Celtic Commercial/Exchange	$110.88
Rate for Payer: Health Partners Plans Commercial	$228.00
Rate for Payer: UnitedHealthcare Commercial	$232.80
Rate for Payer: WPPA Commercial	$201.60

PLEURX CATH SYSTEM KIT

Facility

$240.00

Hospital Charge Code	2709377
Hospital Revenue Code	270
Min. Negotiated Rate	$196.80
Max. Negotiated Rate	$232.80
Rate for Payer: Cash Price	$180.00
Rate for Payer: Health Partners Plans Commercial	$228.00
Rate for Payer: UnitedHealthcare Commercial	$232.80
Rate for Payer: WPPA Commercial	$196.80

PLUM BLOOD IV SET

Facility

$107.00

Hospital Charge Code	2580652
Hospital Revenue Code	270
Min. Negotiated Rate	$49.43
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$80.55
Rate for Payer: Celtic Commercial/Exchange	$49.43
Rate for Payer: Health Partners Plans Commercial	$101.65
Rate for Payer: UnitedHealthcare Commercial	$103.79
Rate for Payer: WPPA Commercial	$89.88

PLUM BLOOD IV SET

Facility

$107.00

Hospital Charge Code	2580652
Hospital Revenue Code	270
Min. Negotiated Rate	$87.74
Max. Negotiated Rate	$103.79
Rate for Payer: Cash Price	$80.55
Rate for Payer: Health Partners Plans Commercial	$101.65
Rate for Payer: UnitedHealthcare Commercial	$103.79
Rate for Payer: WPPA Commercial	$87.74

PLUM ENTERAL IV PUMP SET

Facility

$68.00

Hospital Charge Code	2580678
Hospital Revenue Code	270
Min. Negotiated Rate	$31.42
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$51.00
Rate for Payer: Celtic Commercial/Exchange	$31.42
Rate for Payer: Health Partners Plans Commercial	$64.60
Rate for Payer: UnitedHealthcare Commercial	$65.96
Rate for Payer: WPPA Commercial	$57.12

PLUM ENTERAL IV PUMP SET

Facility

$68.00

Hospital Charge Code	2580678
Hospital Revenue Code	270
Min. Negotiated Rate	$55.76
Max. Negotiated Rate	$65.96
Rate for Payer: Cash Price	$51.00
Rate for Payer: Health Partners Plans Commercial	$64.60
Rate for Payer: UnitedHealthcare Commercial	$65.96
Rate for Payer: WPPA Commercial	$55.76

PLUM IV PUMP TUBING

Facility

$85.00

Hospital Charge Code	2580298
Hospital Revenue Code	270
Min. Negotiated Rate	$39.27
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$64.28
Rate for Payer: Celtic Commercial/Exchange	$39.27
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$71.40

PLUM IV PUMP TUBING

Facility

$85.00

Hospital Charge Code	2580298
Hospital Revenue Code	270
Min. Negotiated Rate	$69.70
Max. Negotiated Rate	$82.45
Rate for Payer: Cash Price	$64.28
Rate for Payer: Health Partners Plans Commercial	$80.75
Rate for Payer: UnitedHealthcare Commercial	$82.45
Rate for Payer: WPPA Commercial	$69.70

PLUM NTG IV TUBING

Facility

$90.00

Hospital Charge Code	2580488
Hospital Revenue Code	270
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$67.84
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$73.80

PLUM NTG IV TUBING

Facility

$90.00

Hospital Charge Code	2580488
Hospital Revenue Code	270
Min. Negotiated Rate	$41.58
Max. Negotiated Rate	$87.30
Rate for Payer: Cash Price	$67.84
Rate for Payer: Celtic Commercial/Exchange	$41.58
Rate for Payer: Health Partners Plans Commercial	$85.50
Rate for Payer: UnitedHealthcare Commercial	$87.30
Rate for Payer: WPPA Commercial	$75.60

PLUM SECONDARY TUBING

Facility

$45.00

Hospital Charge Code	2580181
Hospital Revenue Code	270
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Celtic Commercial/Exchange	$20.79
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$37.80

PLUM SECONDARY TUBING

Facility

$45.00

Hospital Charge Code	2580181
Hospital Revenue Code	270
Min. Negotiated Rate	$36.90
Max. Negotiated Rate	$43.65
Rate for Payer: Cash Price	$33.75
Rate for Payer: Health Partners Plans Commercial	$42.75
Rate for Payer: UnitedHealthcare Commercial	$43.65
Rate for Payer: WPPA Commercial	$36.90

PM AMPHETAMINES QNU

Facility

$110.00

Service Code	HCPCS 80324
Hospital Charge Code	8032400
Hospital Revenue Code	300
Min. Negotiated Rate	$37.14
Max. Negotiated Rate	$106.70
Rate for Payer: BCBS Commercial	$37.14
Rate for Payer: Cash Price	$82.50
Rate for Payer: Cash Price	$82.50
Rate for Payer: Celtic Commercial/Exchange	$50.82
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$92.40

PM AMPHETAMINES QNU

Facility

$110.00

Service Code	HCPCS 80324
Hospital Charge Code	8032400
Hospital Revenue Code	300
Min. Negotiated Rate	$90.20
Max. Negotiated Rate	$106.70
Rate for Payer: Cash Price	$82.50
Rate for Payer: Health Partners Plans Commercial	$104.50
Rate for Payer: UnitedHealthcare Commercial	$106.70
Rate for Payer: WPPA Commercial	$90.20

PMW35 SKIN STAPLER 35W

Facility

$25.00

Hospital Charge Code	2720985
Hospital Revenue Code	270
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$20.50

PMW35 SKIN STAPLER 35W

Facility

$25.00

Hospital Charge Code	2720985
Hospital Revenue Code	270
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$24.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Celtic Commercial/Exchange	$11.55
Rate for Payer: Health Partners Plans Commercial	$23.75
Rate for Payer: UnitedHealthcare Commercial	$24.25
Rate for Payer: WPPA Commercial	$21.00

PNEUMOTHORAX SET

Facility

$405.00

Hospital Charge Code	2704627
Hospital Revenue Code	270
Min. Negotiated Rate	$332.10
Max. Negotiated Rate	$392.85
Rate for Payer: Cash Price	$303.75
Rate for Payer: Health Partners Plans Commercial	$384.75
Rate for Payer: UnitedHealthcare Commercial	$392.85
Rate for Payer: WPPA Commercial	$332.10

PNEUMOTHORAX SET

Facility

$405.00

Hospital Charge Code	2704627
Hospital Revenue Code	270
Min. Negotiated Rate	$187.11
Max. Negotiated Rate	$392.85
Rate for Payer: Cash Price	$303.75
Rate for Payer: Celtic Commercial/Exchange	$187.11
Rate for Payer: Health Partners Plans Commercial	$384.75
Rate for Payer: UnitedHealthcare Commercial	$392.85
Rate for Payer: WPPA Commercial	$340.20

PNEUMOTHORAX WITH CC

Facility

$9,554.46

Service Code	MSDRG 200
Min. Negotiated Rate	$9,554.46
Max. Negotiated Rate	$9,554.46
Rate for Payer: BCBS Commercial	$9,554.46

PNEUMOTHORAX WITH MCC

Facility

$15,887.15

Service Code	MSDRG 199
Min. Negotiated Rate	$15,887.15
Max. Negotiated Rate	$15,887.15
Rate for Payer: BCBS Commercial	$15,887.15

Know your out-of-pocket cost for care.

All Charges